Provider Demographics
NPI:1093056251
Name:ROMAN, JENNY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:J
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 PONCE DE LEON BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2072
Mailing Address - Country:US
Mailing Address - Phone:305-448-1999
Mailing Address - Fax:305-448-1985
Practice Address - Street 1:747 PONCE DE LEON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2072
Practice Address - Country:US
Practice Address - Phone:305-448-1999
Practice Address - Fax:305-448-1985
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL164861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice